How to avoid the 7 most common running injuries

Whether you run for general cardiovascular exercise or race competitively, running is one of the simplest and easiest sports to pick up in all stages of life. All you need is a pair of running shoes and 30 minutes of your day. As gyms in part of the country remain closed, we've been seeing an increased volume of runners seeking information on how to get into running properly to avoid common running injuries. 

The most common injuries:

1. Patellofemoral Pain Syndrome (Runner's Knee)

2. Shin Splints

3. Achilles Tendonitis

4. Plantar Fasciitis

5. Hamstring Strain

6. Iliotibial band syndrome

7. Stress fracture

1. Physiological Adaptation - Running is an extremely high impact, repetitive sport that involves loading 4x your bodyweight on to one leg with every single STEP. Load attenuation is the body's ability (muscles, tendons, ligaments) to absorb the load placed on it and how efficient the body is at recovering from the load between workouts. I always recommend clients ease into running slowly. For clients who have no running background, a run/walk program is appropriate. Revo run coach Kim Springborn emphasizes to her athletes that "You can not expect your body to adapt over night,  start with short intervals of 30 seconds and 1 minute with short moving rests. This will help you perform with better form. You may be physically fit and feel you can do more. Just remember your tendons and ligaments may not agree, they need more time to adapt than your muscles. Patience!" A common error of running involves running too much too soon and when the body isn't able to adapt to the load, it is more likely to break down and succumb to overuse injuries such as stress fractures, shin splints, and achilles tendonitis.

2. Proper Running Shoes - A good running shoe complements a strong foot. Keep in mind that running shoes do not injure a runner, but should complement a runner who is doing all adequate strength and mobility work. Selecting a proper pair of running shoes for most runners is a simpler task than one may think. Shoe technology has evolved significantly in the last few decades and there is an increased amount of confusing jargon on the market. Historically, running shoes have been categorized into neutral, stability, and motion control shoes based on foot arch height and amount/rate of pronation during running. A neutral shoe is typically recommended for someone with a normal to high arch, whereas motion control is on the extreme end for a rapid overpronator. Research by Dr. Benno Niggs Human Performance Lab found no correlation between 1) foot pronation and injury risk and 2) that a stable shoe for pronators reduces injury. Niggs research supports selecting a running shoe that feels most natural to your foot motion. Another common error I find for most runners is poor fit. You should have half a thumbs width between your big toe and the tip of the toe box, as well as a wide enough toe box to support the width of your forefoot. I recommend using Running Warehouse's Shoe fit guide to determine if you need to order a wide width shoe to accommodate your foot shape. Wearing shoes that are too narrow can lead to bunions and poor big toe mobility, and wear shoes too small in length can cause unnecessary blisters and calluses. https://www.runningwarehouse.com/learningcenter/gear_guides/footwear/fittips.html

3. Running Form - While running seems to be as simple as moving one foot in front of the other with a cycle of arm swings, running form is significantly important in preventing the most common running injuries. In novice runners, the most common error is a combination of overstriding, an upright trunk, and excessive knee valgus.

A. Overstriding - landing the foot far in front of the body's center of mass, or in other words, reaching for every stride. Runners who overstride are far more likely to land with an excessive heel strike which causes a breaking impulse that increases the force through the ankle and tibia instead of absorbing the force through the hip (biggest, more durable joint in the body). The research suggests it doesn't matter what foot strike you land with, the most important thing is landing as close to underneath your center of mass as possible. A simple trick to decrease overstriding is to increase cadence (or step rate). Normal cadence is between 160-180 steps/min. Revo run coach Kim recommends " At the beginning of a run and at the end of the run count your cadence of one foot for 30 seconds, make sure you're not slowing down the steps, the next time you go out try to increase the steps per 30 seconds by 2 or 3 more.  An average cadence for a run is ideally 180 steps per minute." Overstriding can be an underlying cause to shin splints, achilles tendonitis, plantar fasciitis, and stress fractures.

B. Upright Trunk - A stiff and upright trunk decreases the amount of hip hinge during mid stance and consequently decreases the amount of potential energy produced in the glute max to produce force during push off phase of running. Midstance is a phase of running when all body weight is on one leg and is the most vulnerable phase for injuries to occur. How your form presents during mid stance shows how efficient your body is at absorbing landing forces properly. An upright trunk is typically caused by poor habit or, not enough glute strength. Ultimately, running cues to reinforce a slight trunk lean at mid stance will effectively decrease overstraining by shifting the body's center of mass.

C. Dynamic Knee Valgus - a medical term for abnormal knee motion characterized by the knee collapsing towards the midline of the body during mid stance phase of running. The knee is a hinge joint and moves in the sagittal plane much like a swinging door. When we start to see rotation of the knee (collapsing motion), this tells us there is lack of control coming from the hip. Dynamic knee valgus is a common contributor of runner’s knee, Iliotibial band syndrome, achilles tendonitis.

5. Mobility Work - Refers to good range of motion through the hips, ankles, and big toe. Constant muscle tightness caused by trigger points or adhesions within muscle tissue can lead to limitations in movement, as well as limit the load distribution through muscle fibers and the joint. A good mobility routine involves daily foam rolling, stretching, and glute activation exercises (mini band). Glute activation should be done prior to running in order to engage these muscles during running (attach video below). Foam rolling is a form of self myofascial release that promotes blood flow to tissues, can decrease trigger points and inflammation. Mobility work is a crucial component of recovery, which is equally as important as running.

Glute Activation Exercises with a mini-bad

Mobility: 1x/day

1. Couch Stretch 2 min hold/side. Keep the stretch at a mild intensity.

2. Foam roll quads 2min/side

3. Foam roll Adductors 2 min/side

5. Lacrosse ball to calves 2 min/side

6. Lacrosse ball to Glutes (against wall or sitting on ball) 2 min/side

7. Psoas Release 2 min/side

8. Standing gastroc stretch 2 min hold, mild intensity. 

Citations: 

Nigg B, Baltich J, Hoerzer S, et al. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’British Journal of Sports Medicine 2015;49:1290-1294.